title: Decreased fertility among female childhood cancer survivors who received 22-27 Gy hypothalamic/pituitary irradiation: a report from the Childhood Cancer Survivor Study.
abstract: OBJECTIVE
  To evaluate the effect of hypothalamic/pituitary radiation (HPT RT) dose on the occurrence of first pregnancy.
  
  
  METHODS
  Retrospective cohort study of childhood cancer 5-year survivors (CCS) diagnosed between 1970 and 1986 before 21 years of age at one of 26 North American pediatric cancer treatment centers.
  
  
  METHODS
  Self-administered questionnaire.
  
  
  METHODS
  A total of 3,619 female CCS who participated in the Childhood Cancer Survivor Study and received no or scatter (≤0.1 Gy) radiation to the ovaries and 2,081 female siblings (Sibs) of the participants.
  
  
  METHODS
  None.
  
  
  METHODS
  Self-reported pregnancy events.
  
  
  RESULTS
  As a group, CCS were as likely to report being pregnant as Sibs (hazard ratio 1.07, 95% confidence interval 0.97-1.19). Multivariable models showed a significant decrease in the risk of pregnancy with HPT RT doses≥22 Gy compared with those CCS receiving no HPT RT.
  
  
  CONCLUSIONS
  These results support the hypothesis that exposures of 22-27 Gy HPT RT may be a contributing factor to infertility among female CCS.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-2794, USA. daniel.green@stjude.org
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.forename: Vikki G
authors.initials: VG
authors.lastname: Nolan
authors.forename: Toana
authors.initials: T
authors.lastname: Kawashima
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
authors.forename: DeoKumar
authors.initials: D
authors.lastname: Srivastava
authors.forename: Wendy
authors.initials: W
authors.lastname: Leisenring
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
mesh_terms: D017668:Age of Onset; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000473:pathology / Q000528:radiation effects*; D007247:Infertility, Female / Q000453:epidemiology / Q000209:etiology*; D009369:Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000532:radiotherapy* / Q000534:rehabilitation; D010902:Pituitary Gland / Q000473:pathology / Q000528:radiation effects*; D011247:Pregnancy; D011832:Radiation Injuries / Q000453:epidemiology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D017741:Survivors